| NPI | 1578828471 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: MA 269442) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: CT 69358) |
| Enumeration Date | 2012-07-08 |
| Last Update Date | 2021-08-25 |